Vet’s 2025 Guide to Canine Pyometra & Endometrial Hyperplasia Life-Saving Diagnosis & Treatment🩺

By Dr. Duncan Houston BVSc

💡 What Are Pyometra & Endometrial Hyperplasia?

Cystic endometrial hyperplasia (CEH) is the thickening of the uterine lining with cyst formation due to repeated progesterone exposure. Pyometra is a life-threatening infection that follows when bacteria invade the cystic cavity, creating a pus-filled cavity. These conditions often occur together, commonly in older intact bitches.

⚠️ Why It Matters

• CEH creates an ideal environment for bacterial infection, leading to pyometra.
• Pyometra is an emergency—mortality is high if untreated, especially in closed form.
• Treatment options vary: surgery is fast; medical therapy is possible in select breeders.

🫁 Who Is at Risk?

• Unspayed females, typically 4–10+ years old; breeds vary.
• PCE therapy (progesterone/estrogen) further raises risk.
• Nulliparous dogs are at higher risk than those that have whelped.

🚩 Clinical Signs

Symptoms depend on whether the cervix is open or closed:

• Open pyometra: pus discharge from vulva, often odoriferous; systemic signs may be mild.
• Closed pyometra: no discharge, severe illness—anorexia, vomiting, PU/PD (urination/thirst), abdominal distension, weakness.
• Other signs: fever, dehydration, pale gums, lethargy.

🧪 Diagnostic Work-Up

• History & exam: intact female with uterine signs post-heat.
• Bloodwork: high WBC, elevated globulins, azotemia, low urine specific gravity.
• Imaging:
  • X-ray: enlarged fluid/gas-filled uterus, especially in closed pyometra.
  • Ultrasound: distended uterine horns, echogenic/intraluminal fluid consistent with pyometra or CEH.

🩺 Treatment Options (2025 Standard)

1. Emergency Ovariohysterectomy (Spay) 🏥

• Gold standard—removes infected uterus and ovaries.
• Pre-op stabilization: IV fluids, broad-spectrum antibiotics (e.g., amoxiclav + enrofloxacin).
• Post-op care: Continue antibiotics for ≥14 days, recheck bloodwork.

2. Medical Management—Selective Use 🌱

• Reserved for breeders or poor anesthetic candidates.
• Drugs used:
  • Prostaglandins (dinoprost/cloprostenol) to expel uterine contents.
  • Progesterone antagonists (aglepristone) or dopamine agonists (cabergoline) to lower progesterone.
• Requires strict monitoring with daily ultrasound; stable open cervix cases only.
• Success rate is good in select cases; fertility outcome variable (14–92 %).

3. Supportive Care for All Dogs

• IV fluids for dehydration and shock.
• Correct electrolyte imbalances, treat sepsis.
• Pain management as needed.

📅 Recovery & Long-Term Outlook

• With surgery: hospital stay 2–5 days; quick improvement in appetite and hydration.
• Medical: requires close monitoring, slower recovery; may recur—about 20 % risk.
• Closed pyometra complications: uterine rupture, peritonitis, kidney failure, death if untreated.
• Spaying eliminates recurrence; medical therapy may preserve breeding potential but carries risk.

🏡 Ask A Vet Home Support

• Track appetite, vomiting, discharge, drinking/urination daily.
• Reminders: meds, rechecks, ultrasound follow-ups.
• Photo logging: vulva discharge, abdominal swelling.
• Alerts for fever, lethargy, anorexia, recurrent bleeding.
• Reminders for spay scheduling and breeding consultation.

🔍 Key Takeaways

• CEH is common in older intact bitches and often precedes pyometra.
• Pyometra is a surgical emergency—spaying plus stabilization saves lives.
• Medical treatment is a possible option for breeders, with careful case selection.
• Prompt treatment is vital—untreated cases can quickly become fatal, especially in closed pyometra.
• At-home monitoring via Ask A Vet keeps recovery on track and relapse rare.

🩺 Final Word ❤️

Pyometra in dogs is a serious but treatable disease, especially when diagnosed early and managed properly. In 2025, veterinary care combines emergency surgery, refined medical options for breeders, and personalized home-care monitoring with Ask A Vet. Together, we ensure safer recoveries, fewer relapses, and healthier lives for our beloved bitches. 🐾✨

Visit AskAVet.com and download the Ask A Vet app to track symptoms, medications, breeding decisions, follow-up scans, and stay connected with your vet—anytime, anywhere. 📲